Sharma Gopal, Sharma Sneha, Parmar Kalpesh
Department of Urology, PGIMER, Chandigarh, India.
Department of Burns and Plastic Surgery, VMMC and SJH, New Delhi, India.
Indian J Urol. 2020 Apr-Jun;36(2):81-88. doi: 10.4103/iju.IJU_298_19. Epub 2020 Apr 7.
Penile skin (PSG) and the buccal mucosa (BMGs) are the most commonly used grafts for substitution urethroplasty. The aim of this study was to compare the success rates of substitution urethroplasty using either of these grafts. We systematically searched PubMed/Medline, EMBASE, Scopus and Web of science to identify studies comparing the two types of graft urethroplasties. Search strategy was based on Patient, Intervention, Control and Outcome guidelines. Studies reporting data on success of PSG versus BMG within the same manuscript were included. Standard Preferred reporting Items for Systematic reviews and Metaanalysis guidelines were followed while conducting this review and study protocol was registered with PROSPERO in priori (CRD42018114258). Sixteen studies, including 5 prospective and 11 retrospective studies, with a total of 1406 (896 BMG and 510 PSG) patients were included in the final analysis. In the overall analysis, BMG had significantly higher success rate (83.7% vs. 76.1%, ≤ 0.0001). Duration of followup was heterogeneous across the studies, ranging from 15.9 to 201 months. Comparing the five studies where the data on duration of follow up was available, BMG showed a significantly higher success rate compared to PSG (90% vs. 80.4%; = 0.02). In the subgroup of patients with bulbar urethral strictures, BMG urethroplasty had significantly higher success rate (87.4% vs. 78.0%; = 0.0001). From the results of this study, buccal mucosa may appear to be a better choice, however, the data is still immature and a properly conducted randomized controlled trial with an adequate duration of followup is required.
阴茎皮肤（PSG）和颊黏膜（BMG）是替代尿道成形术中最常用的移植物。本研究的目的是比较使用这两种移植物进行替代尿道成形术的成功率。我们系统地检索了PubMed/Medline、EMBASE、Scopus和科学网，以确定比较这两种移植物尿道成形术的研究。检索策略基于患者、干预措施、对照和结果指南。纳入在同一篇手稿中报告PSG与BMG成功率数据的研究。在进行本综述时遵循了系统评价和Meta分析的标准首选报告项目指南，并且研究方案已事先在PROSPERO注册（CRD42018114258）。最终分析纳入了16项研究，包括5项前瞻性研究和11项回顾性研究，共有1406例患者（896例BMG和510例PSG）。在总体分析中，BMG的成功率显著更高（83.7%对76.1%，≤0.0001）。各研究的随访时间不一致，范围为15.9至201个月。在可获得随访时间数据的五项研究中进行比较，BMG的成功率显著高于PSG（90%对80.4%；=0.02）。在球部尿道狭窄患者亚组中，BMG尿道成形术的成功率显著更高（87.4%对78.0%；=0.0001）。从本研究结果来看，颊黏膜似乎是更好的选择，然而，数据仍然不成熟，需要进行一项随访时间足够的恰当随机对照试验。
